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Kusoma Haraka Wakati wa Kusoma: 3 dakika

Biashara Ambayo Haijakamilika kwa Upatikanaji wa Kuzuia Mimba na Kuzuia VVU

The landmark Evidence for Contraceptive Options and HIV Outcomes (ECHO) Study is the first large-scale randomized clinical trial to investigate the relationship between the use of hormonal family planning methods and the risk of HIV acquisitiona double burden far too many women still face. Although the study’s results have yielded valuable information, our colleagues at FHI 360 explain that there is still plenty of work to do.

Great strides have been made in expanded access to family planning care and HIV prevention services; hata hivyo, women continue to suffer the dual burdens of unintended pregnancy and HIV infection. Concerns that contraception itself might increase the risk of HIV acquisition led to the design and implementation of the landmark ECHO trial. ECHO was a randomized clinical trial comparing HIV incidence, adverse events, and pregnancy rates among 7,829 African women randomized to three licensed contraceptive products: intramuscular depot medroxyprogesterone acetate (DMPA), a copper intrauterine device, and a levonorgestrel implant. The results were presented at a conference in Durban, South Africa in June 2019 na published in The Lancet. HIV incidence was similar across the three groups and all methods were safe and highly effective. In light of the ECHO results, the World Health Organization (WHO) convened an expert group to review the data on contraceptive eligibility for women at high risk for HIV acquisition and issued updated guidance in August 2019, which indicated that all trial methods could be safely used by women at high HIV risk.

The ECHO study identified a very high overall HIV incidence of 3.8 per 100 women-years among the young study participants (median age 23 miaka) seeking contraception in the four study countries: Eswatini, Kenya, South Africa, na Zambia. This alarming finding among women who were provided HIV prevention services, including STI screening, condoms, and pre-exposure prophylaxis (PrEP) later in the trial, tempered the encouraging news of no difference in HIV risk by contraceptive method. Discussion of this finding led to calls for urgent and aggressive measures to expand women-centric HIV prevention services, including PrEP, for women in family planning programs. The findings also supported expanded access to the full range of contraceptive products for women at high HIV risk. WHO initiated a concerted effort to support country programs, especially in Africa, to act aggressively on the ECHO findings to enhance FP-HIV integration.

DMPA-IM, 2-rod levonorgestrel implant, and the copper IUD. Photo credit: Leanne Gray
DMPA IM, 2-fimbo levonorgestrel implant, na IUD ya shaba. Sadaka ya picha: Leanne Grey

Now, katika 2021, we are confronted with the additional challenge of the COVID-19 pandemic on access to both family planning care and HIV prevention services. With regard to family planning, important steps to maintain access to critical family planning care for women and girls include using telehealth for counseling, uchunguzi, method provision, and side effects management; extended use of IUDs and implants; and self-administration of Sayana Press (DMPA-SC). Kwa bahati mbaya, many programs have seen drops in attendance and early signs of increased pregnancy rates among young women.

The COVID-19 pandemic has also challenged HIV prevention, kujali, na matibabu programu. In many areas where women are at greatest HIV risk, scale up of PrEP is still at an early stage. Linking PrEP services with family planning offers a “win-win” opportunity. The recent European Medicines Agency endorsement of the dapivirine vaginal ring for HIV prevention for women in high HIV burden settings should lead to a complementary prevention approach in addition to safer sex practices when women cannot take or do not have access to oral PrEP. Zaidi ya hayo, the HIV Prevention Trials Network recently announced that a trial evaluating the safety and efficacy of long-acting injectable cabotegravir (CAB LA) for PrEP in women in Africa was stopped early by the Data and Safety Monitoring Board when CAB LA was found to be superior to oral PrEP in preventing HIV acquisition. The addition of a long-acting injectable PrEP agent to the prevention toolbox should help mitigate access and adherence challenges. Moreover, the 8-week injection schedule can be synchronized to injectable contraceptive provision. Ongoing research will hopefully yield multipurpose technologies that prevent both pregnancy and HIV.

At the completion of the ECHO study, the greatest fear of study investigators was that the world of family planning and HIV prevention would return to business as usual, and not continue to act on the critically important findings for women’s health. Now, with the triple threats of COVID-19, VVU, and unintended pregnancy, we must move decisively to assure that the fear of returning to business as usual, or even business less than usual, is not realized.

 

To learn more about how to adapt family planning and contraceptive access in the current pandemic context, check out our COVID-19 maudhui.

Biashara Ambayo Haijakamilika kwa Upatikanaji wa Kuzuia Mimba na Kuzuia VVU
Timotheo D. Mastro, MD, DTM&H

Afisa Mkuu wa Sayansi, FHI 360

Timotheo D. Mastro, MD, DTM&H ni Afisa Mkuu wa Sayansi katika FHI 360, Durham, Carolina Kaskazini. Yeye pia ni Profesa Msaidizi wa Epidemiology katika Shule ya Gillings ya Afya ya Umma Ulimwenguni, Chuo Kikuu cha North Carolina huko Chapel Hill. Anasimamia programu za utafiti na sayansi za FHI 360 zinazofanywa Marekani na kupitia ofisi za FHI 360 nchini. 50 mataifa duniani kote. Dk. Mastro alijiunga na FHI 360 katika 2008 kufuata 20 miaka katika nyadhifa za uongozi wa kisayansi katika Vituo vya Marekani vya Kudhibiti na Kuzuia Magonjwa (CDC). Kazi yake imeshughulikia utafiti na programu juu ya matibabu na kuzuia VVU, TB, Magonjwa ya zinaa na afya ya uzazi, ikiwa ni pamoja na kuhudumu katika kamati ya usimamizi wa kisayansi kwa ajili ya jaribio la kimatibabu la ECHO linalochunguza hatari ya kupata VVU na manufaa kwa njia tatu za uzazi wa mpango miongoni mwa wanawake barani Afrika..

Kavita Nanda, MD, MHS

Mkurugenzi wa Utafiti wa Matibabu, Maendeleo ya Bidhaa na Utangulizi, FHI 360

Kavita Nanda, MD, MHS, Mkurugenzi wa Utafiti wa Matibabu, FHI 360, ni daktari wa uzazi/mwanajinakolojia ambaye amejitolea kazi yake katika kuendeleza na kuboresha matumizi ya njia za uzazi wa mpango kwa wanawake.. Alikuwa mpelelezi mwenza na mwenyekiti wa kamati ya usalama wa uzazi wa mpango kwa Ushahidi wa Chaguzi za Kuzuia Mimba. (ECHO) jaribio, jaribio la nasibu la vituo vingi vya vidhibiti mimba vitatu tofauti na upatikanaji wa VVU 7,800 Wanawake wa Kiafrika walio katika hatari kubwa ya VVU. Dk. Nanda amewahi kuwa mpelelezi mkuu wa FHI kadhaa 360 masomo, ikiwa ni pamoja na kushughulikia usalama wa vidhibiti mimba vyenye homoni miongoni mwa wanawake wenye hali mbalimbali za kiafya, na kama mkurugenzi wa utafiti wa matibabu kwa majaribio kadhaa makubwa ya kuzuia VVU. Kwa sasa, Dk. Nanda ni mkurugenzi wa mpango wa kutengeneza kipandikizi kipya kinachoweza kuharibika kwa ajili ya uzazi wa mpango unaofadhiliwa na Bill and Melinda Gates Foundation..

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